REPORT TO

THE CITY

2022

1

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

TABLE OF CONTENTS

Letter from the CEO

......................................................................................................................................

3

2022 Year in Review

........................................................................................................................................

6

Denver Health Performance

2022 Denver Health Regulatory Surveys

...........................................................................................................

12

Patient Care Services (A-1)

.........................................................................................................................................

16

Emergency Medical Services (A-2)

.......................................................................................................................

34

Public Health Services (A-3)

.......................................................................................................................................

38

Denver Community Addiction Rehabilitation and Evaluation Services (CARES) (A-4) ..44

Medical Services for Arrestees, Pretrial Detainees and Inmates (A-6)

.......................................

48

Denver Health Medical Plan and City Employee Health Care Opinion Survey (A-7)

........

52

Rocky Mountain Poison and Drug Safety Services (RMPDS) (A-8)

................................................

56

Clinical and Laboratory Services for the City's Department of Public Health &

Environment (A-9)

.............................................................................................................................................................

60

Center for Occupational Safety and Health (COSH) and Worker's Compensation Triage

Line (OUCH Line) (B-1)

....................................................................................................................................................

62

NurseLine Services (B-2)

...............................................................................................................................................

66

Acute and Chronic Health Care at Denver County Jail and Downtown Detention Center

(B-3)

.............................................................................................................................................................................................

70

Miscellaneous Services for DDPHE (B-7)

...........................................................................................................

72

Miscellaneous Services for the Department of Public Safety (B-8)

..............................................

76

Miscellaneous Services, Other (B-9)

.....................................................................................................................

80

Uncompensated Care

...................................................................................................................................

82

Financial Statements

...................................................................................................................................

84

Contract Reconciliation

..............................................................................................................................

88

2

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

01

Letter from

the CEO

3

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

4

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Honorable Mayor Michael B. Hancock

City and County of Denver

1437 N. Bannock Street, Room 350

Denver, CO 80202

April 22, 2023

Dear Mayor Hancock,

As Chief Executive Officer of Denver Health, it is an honor to share the 2022 Denver Health and Hospital

Authority’s Compliance with Operating Agreement Performance Report. With Denver Health’s Operating

Agreement as our guide, the information in this report captures the commitment of Denver’s longest-serving

health care institution – an essential partner to the City. The pride of more than 160 years of dedication

to care for the people of Denver and throughout the state is visible in every highlighted area. By working

together with you and your Administration, we are strengthening the health and safety of our community.

Since becoming Denver Health CEO in September 2022, every day I see how valuable the people and

programs of our city’s safety-net hospital are to the health and wellbeing of our residents – and to the city

and state itself. I’ve met incredible health care workers who remained committed during COVID-19, one of

the most trying health care crises in our country. The past three years have strengthened the resolve of so

many at Denver Health to maintain high-quality care for all patients but especially for those experiencing

the worst of the pandemic. Our team is resilient and determined to maintain operational stability to a health

care organization that so many rely on.

As you will see in the following pages, our reach is well beyond the walls of our main hospital. Care at 10

federally qualified community health centers and 19 Denver Health Pediatrics at Denver Public Schools

extends throughout our community. Denver Health is a training location for hundreds of students and

residents each year, many who connect with our mission and return to working here after completing their

education. Our researchers have successfully secured nearly $97 million in research, training and service

awards in 2022 that fund projects that capture our commitment to learning and translating new findings to

improve the care experience nationwide and even throughout the world.

It’s a time of great change for our city and our health care system. This report shows the incredible impact

we have despite our challenges, highlights what’s possible when working on behalf of others, and captures

the powerful relationship and commitment to our agreement with the City and service the people and

community it serves.

Sincerely,

Donna Lynne, DrPH

Chief Executive Officer

Denver Health

5

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

02

2022 Year

in

Review

6

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

7

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

A Year In Review

While 2022 provided many

challenges throughout health

care – including ongoing fallout

from the COVID-19 pandemic

and financial hardships for

many health care systems –

Denver Health continued to

provide best-in-class care,

serving the City and County

of Denver and beyond. Our

providers saw more than 1.2

million patients with more than

970,000 patients seen in our

clinics, outside of the hospital.

More patients than ever before

turned to Denver Health to

access mental and oral health

care.

In addition to increases in

patients served, the health care

system made great strides in

new health initiatives and other

exciting achievements. Here is

a selection of that work in 2022.

Denver Health launched

an employee resource group

dedicated to the LGBTQ+

community and allies called

PRISM (Pride Representatives

in Service of Medicine)

. In its

first year, members supported

Pride celebrations, LGBTQ+

History Month and a legislative

statement by Denver Health

on Section 1557 of the Patient

Protection and Affordable

Care Act. PRISM’s mission is

to highlight and celebrate

LGBTQ+ employees by creating,

maintaining and enabling

communication channels

between LGBTQ+ employees,

allies and Denver Health

leadership.

Medical

analytics

publishing

company

Elsevier

placed

Denver Health

surgeon

Ernest E. Moore, MD, among the

top five most-cited surgeon-

scientists in the world

. Dr. Moore,

renown trauma surgeon and

director of trauma research at

Denver Health, is internationally

recognized for his expertise.

Dr. Moore, after whom Denver

Health’s Ernest E. Moore Shock

Trauma Center is named,

continues to advance the study

of trauma care worldwide.

The Colorado Academy of

Family Physicians honored Lowry

Family Health Center with the

Practice Award for Health Equity

& Community Engagement

.

The award highlights practices

in family

medicine

making

progress in

reducing

racial and

other health

disparities.

Of the 17,400 people who receive

care at Lowry, 16 percent speak

Spanish and another 28 percent

speak a language other than

English or Spanish, and many are

refugees.

Denver Health staff joined

George Washington High

School’s principal at

the opening

of our newest, and 19th, school-

based health center

. Denver

Health’s school-based health

centers provides physical and

behavioral health care services

FEBRUARY

to Denver Public Schools students

at no cost. It’s estimated that

the center’s staff at George

Washington will care for more

than 1,200 youth per year.

Denver Health’s

Refugee Clinic

hosted visitors from around the

world

who came to learn how

we screen patients and to take

those ideas back to their own

countries. About 20 people who

lead resettlement efforts in other

nations, including Australia,

Switzerland, Belgium and the

United Kingdom, toured the

Lowry Family Health Center.

Denver Health’s Afghan Refugee

Response Team has screened

more than 1,000 evacuees since

the United States ended military

operations in Afghanistan.

The Pediatric Academic Society

recognized Denver Health’s

Division of General Pediatrics

and School Health with the

2022

Health Care Delivery Award

. The

award recognized multipronged

COVID-19 efforts focused on

students and families in Denver.

At a national conference, the

society highlighted our telehealth

innovations, vaccination

accomplishments and school

partnerships promoting safety in

the pandemic.

The Denver Prevention Training

Center (DPTC), a program of the

Public Health Institute at Denver

Health, secured over

$1.2 Million

in new grant funding

to support

its National Network of STD

MARCH

APRIL

8

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Clinical Training Center (NNPTC)

and Disease Intervention Training

Center (DITC) efforts.

As part

of these grants, the DPTC has

facilitated and delivered mpox

training. The DPTC also delivered

additional disease intervention

training as part of the American

Rescue Act to address emerging

public health issues.

Denver Health and its public

health clinics began supporting

the mpox response in Denver,

the metro region, and across the

state. Public health providers

emerged as local experts in the

mpox response, supporting other

departments at Denver Health

as well as partners and the

community. Public health clinics

later would begin offering TPOXX

treatment in June under a special

investigational drug protocol,

and Denver Health initially was

the only organization in Colorado

providing the treatment.

Denver Health’s Ambulatory

Care Services Quality

Improvement team

honored

six employees and three

clinics as Quality Heroes

.

The annual awards recognize

primary care providers, medical

assistants and clinics across

Denver Health with the highest

scores in quality improvement

goals, such as screenings for

cervical cancer, controlling

high blood pressure, evaluating

kidney health, following up on

depression and closing gaps in

care. The Westside Pediatrics

clinic, internal medicine at the

Westside Adult clinic, and family

medicine at the Montbello

Family Health Center scored the

highest among Denver Health

clinics.

The Denver Health

Pediatric

Dental Residency Program’s

first class of residents started

in

the Webb building on the main

campus for a two-year program

that, once fully operational, is

expected to increase patient

capacity for pediatric dentistry

to over 2,000 patient visits a

month. In addition, specialty

pediatric dental care allows for

more access to our most at-risk

populations for treatment under

general anesthesia and sedation.

Duane Mata, MD, director of

dentistry for community health,

sees this as the first step in

establishing Denver Health as a

leader in children’s oral health for

not only Denver County but the

entire metro area.

The nonprofit LGBTQ+

advocacy organization

Human

Rights Campaign designated

Denver Health as a leader in

health care equality

. Our health

care system is one of only two

hospitals in Colorado to receive

the 2022 recognition, marked by

our 100-point score – the highest

possible – on the Healthcare

Equality Index. The national

benchmarking tool evaluates

health care facilities’ policies and

practices related to the equity

and inclusion of LGBTQ+ patients,

visitors and employees.

MAY

The

Infectious Diseases (ID)

Clinic within the Public Health

Institute at Denver Health

secured over $500,000 in new

grant funding

to implement a

low-barrier, drop-in subspecialty

clinic for people with HIV.

Modeled after the MAX Clinic in

Seattle, the Direct Access to Care

Environment (DACE) Clinic will

provide nontraditional means

of care access to those with the

most need. Spanning 32 months

of funding, this intervention will

help to achieve and sustain our

organization’s commitment of

advancing health equity while

working to close gaps within

the HIV care continuum. The ID

Clinic was one of three national

sites selected to receive this

grant funding for MAX Clinic

implementation.

Fifty-eight physicians at

Denver Health made the list of

“Top Doctors” in 5280 magazine

.

Featured among 343 doctors in

the Denver metro area’s seven

counties, honorees were voted by

other doctors as the physician

they would most want caring for

themselves and their families.

The

Nurse Residency Program

received accreditation with

distinction

from the American

Nurses

Credentialing

Center (ANCC)

Practice

Transition

Accreditation

Program (PTAP).

The ANCC PTAP

sets the global

standard for nurse residency

programs that transition

graduate nurses into professional

practice. Our program is the only

nurse residency program in the

Denver metro area to achieve the

accreditation.

AUGUST

JUNE

JULY

9

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Denver Health launched the

Access Transformative Outreach

Program (ATOP) to help patients

with severe substance use

disorders

. ATOP is an intensive,

community-based intervention

program in partnership with

Colorado Access. Most patients

are experiencing homelessness,

have significant medical or

mental health conditions, and

lack family or social support.

Former

Colorado Lt.

Gov.

Donna

Lynne, DrPH,

took over

as CEO

of Denver

Health

,

beginning

another

chapter in our more than 160-

year history. Since her start,

our new CEO has fostered

an unprecedented level

of engagement with staff,

particularly during new CEO

listening sessions in the fall and

winter, receiving and responding

to questions and feedback from

the thousands of employees

who attended those sessions.

“One tenet I live by,” Lynne said,

“is best expressed by Albert

Schweitzer: ‘The purpose of

human life is to serve, and to

show compassion and the will to

help others.’”

Forbes named Denver Health

as one of America’s Best-

in-State Employers of 2022

.

This recognition was created

through a survey of 70,000 U.S.

employees across 25 industry

sectors. The survey considered

every aspect of an employee’s

experience such as working

conditions, salary, diversity and

potential for growth.

Denver Health has the second-

ranked emergency medicine

residency program in the

country

, based on reputation

scores. The ranking by health

care platform Doximity’s

Residency Navigator is based on

more than 300,000 reviews and

ratings from more than 125,000

physicians, including current

residents and recent alumni.

Denver Health is ranked below

only the Los Angeles County and

University of Southern California

Medical Center in Los Angeles.

Rocky Mountain Poison &

Drug Safety participated in the

Denver Fentanyl Action Summit

.

Data from the Researched

Abuse, Diversion and Addiction-

Related Surveillance (RADARS)

initiative were shared to describe

fentanyl use and treatment

opportunities in Denver and to

educate stakeholders to help

address the fentanyl crisis in the

community.

SEPTEMBER

OCTOBER

The

2022 Vizient Quality and

Accountability scorecards

showed Denver Health ranked

in the top 10% in medication

communication and

responsiveness of staff; top 20%

for doctor communication; top

30% for nurse communication,

cleanliness and quietness, and

discharge information; and top

40% for overall hospital rating.

Denver Health’s

At-risk

Intervention and Mentoring

(AIM)

, a hospital-based violence

intervention program that

uses a multidisciplinary, public

health approach to stop the

cycle of violence, performed 353

bedside interventions, reached

1,083 individuals and responded

to 45 crisis situations in the

community, and performed 25

trauma-informed care trainings.

AIM combines its hospital-based

work with partnerships with

numerous community-based

organizations, Denver Public

Schools and the Denver Police

Department, to comprehensively

address social determinants of

health. AIM was awarded $1.4

million in grants from the United

States Department of Justice

and Colorado Department of

Public Safety to expand its

services and perform rigorous

program evaluation.

The

Bariatric Surgery Center

reached 125 cases in a year

for the first time

, up from 102

cases in 2021. This has been the

bariatric surgery team’s goal for

years, and the milestone allows

the center to contract with all

commercial payers.

10

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Greenhealth for its efforts in 2022.

Denver Health was honored with

the Partner for Change Award

and the Circle of Excellence

Award for Energy

. They follow

2021’s Environmental Excellence

Award, which recognized Denver

Health’s “superior performance in

environmental sustainability.”

Denver Health staff once again

displayed their commitment to

our community and patients

as a multidisciplinary team

mobilized to provide medical

care, assessment, treatment

and vaccinations to a flood of

migrants who unexpectedly

arrived in Denver by bus. In

partnership with the Denver

Department of Public Health and

Environment,

the team deployed

a mobile health center to

emergency shelters

and helped

hundreds of our new neighbors.

The

Infant Mental Health

program at Denver Health

celebrated another year of

having specialists who work with

children at all 10 Denver Health

community health centers. This

innovative program provides a

multigenerational approach to

mental health care, focusing on

both the child and the caregivers.

The goal is to prevent the

emotional, social and financial

costs of adverse childhood

experiences and toxic stress as

the child grows and matures.

DECEMBER

NOVEMBER

The

American College of

Surgeons approved the Bariatric

Surgery Center's accreditation

,

making Denver Health the

only hospital in Denver that

is Metabolic and Bariatric

Surgery Accreditation and

Quality Improvement Program

(MBSAQIP)-certified for both

adolescents and adults. Our

multidisciplinary adolescent

team will began evaluating

referrals for bariatric surgery in

patients aged 15–20 years, with

surgery offered once patients

turn 16. Denver Health continues

to care for adult bariatric

surgery patients aged 21-65.

The

Denver Health High Risk

Infection Team (HITeam) was

recognized by the National

Emerging Special Pathogens

Training and Education Center

for ensuring readiness and

preparedness for the hospital

and staff in safely treating and

caring for patients with highly

infectious diseases. The HITeam is

staffed by a group of physicians,

registered nurses, respiratory

therapists, medical laboratory

scientists, paramedics, and

emergency medical technicians

who are prepared to identify,

isolate, transport, treat and care

for patients.

The

University of Colorado

School of Medicine recognized

several Denver Health faculty as

outstanding educators

, including

Anne Frank, MD (Internal

Medicine Teacher of the Year),

Jessica Jack, MD (Pediatrics

Teacher of the Year), Shalvi Patel,

MD (Family Medicine Teacher

of the Year), Nathan Grohmann,

MD (Surgery Teacher of the

Year), Jennie Buchanan, MD

(Emergency Medicine Teacher of

the Year), Kate Adkins, MD (OB/

GYN Teacher of the Year. The

physicians were chosen among

nominations from students in the

school's longitudinal integrated

clerkship curriculum.

Denver

Health’s

Security

Operations

Center

(SOC) in

Pavilion

J was

activated

and will

become the 24/7 home for

security dispatchers in 2023,

helping to reduce officers’

response times to incidents

on the main campus. The SOC

is the security team’s new

communications hub, which

allows dispatch to communicate

with officers in the field and

with law enforcement while

monitoring scenes in real time.

Denver Health continues

to make great strides in

environmental sustainability, and

the health care system was once

again recognized by Practice

11

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

03

Denver Health

Performance

12

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

13

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Article V

5.1

Annual Report of the Denver Health and Hospital

Authority to the City

The Authority shall deliver a written annual report to

the City within six months of the end of its Fiscal Year,

commencing with Fiscal Year 1998, which report shall

include:

A.

The latest financial statements of the Authority

which have been audited by an independent auditing

firm selected by the Authority.

Response:

Criteria met

The Authority has provided the City with the

appropriate financial statements which have been

audited by an independent auditing firm. The 2022

financial statements are presented in Section 19 of

this report.

B.

An executive summary of the results of all

regulatory and accreditation surveys with respect

to the Authority which have been completed during

such last Fiscal Year.

Response:

Criteria met

A summary of the results of all regulatory and

accreditation surveys with respect to the Authority is

presented in Section 03 of this report.

C.

A report of the disposition of all matters regarding

the Authority that have been referred to the Liaison

by the Mayor or any member of City Council during

such Fiscal Year.

Response:

Criteria met

All matters referred to the Liaison have been

promptly addressed.

14

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

15

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

04

A-1

Patient

Care Services

16

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

17

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix A-1 Patient Care Services

1.5

Performance Criteria

A.

The Authority shall submit an annual report to the

City which includes the data indicated below in the

Performance Criteria tables in 1.5(g) and 1.5(h) for the

year just ended, as well as the two previous Fiscal

Years, by May 1 following the reporting year.

Response:

Criteria met

The Authority respectfully submits for consideration

the

2022 Report to the City

dated

April 22, 2023

in

compliance with the 2022 Operating Agreement

performance reporting requirements.

G.

Performance Criteria Table - Clinical

(I-W numbering follows the Authority's annual report).

For all criteria, active patients are defined as

empaneled patients who have had a Primary care

visit in the past 18 months.

For performance criteria without goals or targets, a

trend line is provided.

1.5I

Childhood Immunization Rate

Goal:

At least 75% of patients with at least one

medical visit in the last year who became 24 mos of

age in last year who have received 4 DTap, 3 Polio, 1

MMR, 3 HIB, 3 Hepatitis B, 1 Varicella, 4 Pneumococcal

immunizations, 1 Hepatitis A, and 2 or 3 Rotavirus by

24 mos of age.

Response: Criteria not met.

Variance Explanation:

The primary cause for not achieving the target was

missing the window for first roto vaccine dose for

patients transferring care to Denver Health. In 2023,

Denver Health will work with outside hospitals and

organizations to better coordinate care for patients

to get timely appointments within the roto vaccine

window.

1.5J

Percent Women Entering Prenatal Care

Goal:

At least 70% of women will begin care within the

1st trimester.

Response:

Criteria met

1.5L

Patient Satisfaction

Goal - Ambulatory Care:

The mean composite

patient experience score in primary care will be 90%

or greater.

Response:

Criteria not met

Variance Explanation:

Access issues, primarily due to staffing challenges

and high demand, had the greatest impact on

patient experience scores. Improving access to care

at Denver Health is an organization-wide strategic

priority in 2023

.

Goal - Hospital Care:

78% of hospitalized patients

will respond with a 9 or a 10 (“top box”) for overall

patient satisfaction.

Response:

Criteria met

18

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

1.5M

Breast Cancer Screening

Goal:

56% of active female patients age 51 to 74

years will have a mammogram in the past 2 years.

Response:

Criteria met

1.5N

Cervical Cancer Screening

Goal:

70% of active female patients age 24-64, will

have had a PAP test in the past three years or a

PAP+HPV in the past 5 years (age 30-64).

Response:

Criteria met

1.5P

Diabetes Monitoring

A “diabetic patient” is an adult in the diabetes

registry with at least one diagnosis code for diabetes

in the last 18 months.

Goal - Diabetes Glucose Control:

60% of Diabetic

patients will have an HbA1c < 9.

Response:

Criteria met

Goal - Cardiovascular Disease Treatment and

Prevention:

90% of Diabetic patients will receive

guideline-adherent treatment with statin medication.

Response:

Criteria met

1.5O

Adolescent Vaccinations

Goal:

85% of active adolescent patients, age 13-17, will

have at least one does each of Tdap, MCV4, and HPV

vaccine.

Response: Criteria met

19

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

1.5R

Cigarette Smoking Interventions

Goal:

At least 50% of patients 11 years and older who

smoke, had a visit in their medical home in the last

month (and at least one other in the past year) and

who received an approved cessation intervention

anywhere at Denver Health in the past 6 months.

Response:

Criteria met

1.5S

Flu Vaccinations

Goal:

50% of patients, 6 months of age or older

who have had a visit to a primary care clinic

during the influenza season and who do not have

a contraindication to vaccination will receive the

influenza vaccine.

Response:

Criteria met

1.5Q

Hypertension Control

Goal:

62% of patients identified with hypertension

will have their blood pressure under control as

defined by current standards.

Response:

Criteria met

1.5T

Survival with Trauma

Survival rate for blunt and penetrating trauma

among patients who are not dead on arrival (DOA)

will be maintained within 5% of prior year experience.

Goal - Blunt:

Survival rate for blunt trauma will be

maintained within 5% of 2021 experience, which was

97.4%.

Response:

Criteria met

Goal - Penetrating:

Survival rate for penetrating

trauma will be maintained within 5% of 2021

experience, which was 96.3%

Response:

Criteria met

20

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

1.5U

Joint Commission Quality Measures. Early

Elective Delivery between 37-39 Weeks Gestation

Goal:

The rate of elective delivery between 37-39

weeks as defined by the Joint Commission measure

PC-01 will be maintained at 1.5% or lower.

Response:

Criteria met

1.5V

Hospital-Acquired Infection Rates. Adult

Critical Care Central Line Associated Blood Stream

Infection (CLABSI)

Goal - Medical Intensive Care Unit:

Risk-adjusted

rate that is the same or better than the national

Medical ICU rate on the most recent Colorado

Department of Public Health and Environment

(CDPHE) report.

Goal - Trauma Intensive Care Unit:

Risk-adjusted

rate that is the same or better than the national

Trauma ICU rate on the most recent CDPHE report.

Response:

Criteria met

1.5W

HIV Prevention - Pre and Post Exposure

Response:

Criteria met

21

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

H.

Performance Criteria Table - Ambulatory Encounters (1.5 numbering follows the Authority's annual report)

Response:

Criteria met

See table below for details.

22

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

I.

The Authority’s Medical Center's observed total

inpatient mortality will be the same or better

than the expected as measured by Vizient, the

largest member-driven health care performance

improvement company in the country.

Response:

Criteria met

For the most recent full year of data available from

Vizient (October 2021 - September 2022), Denver

Health's observed inpatient mortality was 20% better

than the expected mortality, adjusted for patient

complexity.

J.

The Authority will maintain appropriate

accreditation for the major national accrediting

organizations as a measure of quality care.

Response:

Criteria met

Denver Health maintains full accreditation from The

Joint Commission on five distinct regulatory surveys

covering A) the hospital and specialty clinics, b) the

federally qualified health centers and school-based

clinics, c) the hospital laboratory, d) the ambulatory

care services laboratory, and e) the opioid treatment

program. In 2022, The Joint Commission conducted

both of the laboratory services surveys, resulting in

maintenance of full accreditation.

K.

The Authority will maintain national Residency

Review Committee accreditation for its training

programs.

Response:

Criteria met

Denver Health enjoys Continued Accreditation from

ACGME for its three accredited medical residencies,

Approval without Reporting Requirements

from CODA for its three dental residencies, and

Transferred Accreditation from CPME for its podiatry

residency which relocated from the VA Hospital.

L.

The Authority will include in the May 1 annual

report, a schedule of the number of patients treated

during the reporting year by county, gender and

ethnicity. The Authority will develop a report of the

same data by census tract or zip code for Denver

users. A separate report will be prepared detailing

the same information for the homeless.

Response:

Criteria met

See tables on the following pages for details.

23

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

2022

Rank

DRG#

DRG NAME

Total

2021

Rank

2020

Rank

1

885

PSYCHOSES

108

1

1

2

871

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

72

2

2

3

794

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

54

9

7

4

621

O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

50

N/A

N/A

5

807

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT

CC/MCC

41

N/A

5

6

833

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES

WITHOUT CC/MCC

34

18

N/A

7

872

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT

MCC

33

8

N/A

7

202

BRONCHITIS AND ASTHMA WITH CC/MCC

33

N/A

20

9

641

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS

AND ELECTROLYTES WITHOUT MCC

32

N/A

20

10

917

POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

31

N/A

N/A

11

193

SIMPLE PNEUMONIA AND PLEURISY WITH MCC

29

N/A

N/A

12

603

CELLULITIS WITHOUT MCC

28

N/A

N/A

13

286

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC

CATHETERIZATION WITH MCC

26

21

22

14

419

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT

CC/MCC

24

N/A

N/A

15

897

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT

REHABILITATION THERAPY WITHOUT MCC

23

N/A

N/A

16

640

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS

AND ELECTROLYTES WITH MCC

20

N/A

17

16

832

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES

WITH CC

20

24

N/A

16

247

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-

ELUTING STENT WITHOUT MCC

20

N/A

N/A

19

660

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM

WITH CC

19

N/A

N/A

20

896

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT

REHABILITATION THERAPY WITH MCC

18

N/A

N/A

21

246

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-

ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS

16

N/A

N/A

22

906

HAND PROCEDURES FOR INJURIES

15

N/A

25

22

482

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT

15

N/A

22

22

812

RED BLOOD CELL DISORDERS WITHOUT MCC

15

N/A

N/A

22

795

NORMAL NEWBORN

15

N/A

N/A

26*

494

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP,

FOOT AND FEMUR WITHOUT CC/MCC

14

N/A

N/A

26*

418

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC

14

N/A

N/A

Top 25 DRG's for Medically Indigent Population

*Displaying top 26 DRGs due to four-way tie for 22nd

L.

24

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

County

Users

Visits

Users

Visits

Users

Visits

Users

Visits

Adams

20,819

92,009

27,150

122,883

25,730

115,254

Alamosa

22

73

30

103

29

91

Arapahoe

24,392

106,333

33,137

142,384

28,863

126,786

Archuleta

7

11

13

25

7

71

Baca

1

1

3

6

4

8

Bent

7

15

7

76

10

52

Boulder

1,238

3,345

2,107

5,679

1,546

4,429

Broomfield

579

2,146

941

3,591

746

2,916

Chaffee

27

58

33

87

46

122

Cheyenne

4

13

4

18

8

19

Clear Cree

k

115

294

170

515

149

424

Conejos

5

7

9

28

12

28

Costilla

6

10

5

17

11

35

Crowley

2

5

4

6

6

23

Custer

10

35

10

22

10

40

Delta

16

29

20

64

26

49

Denver

137,906

642,649

179,606

854,392

155,914

740,903

Dolores

2

2

5

11

1

2

Douglas

2,346

8,142

4,476

14,482

2,902

10,520

Eagle

168

370

174

412

218

497

El Paso

937

2,652

1,118

3,301

1,206

3,290

Elbert

109

281

157

510

114

391

Fremont

35

139

48

138

39

102

Garfield

60

155

77

143

82

188

Gilpin

50

213

70

190

61

158

Grand

1,104

2,488

1,543

3,717

948

2,382

Gunnison

23

46

29

59

23

44

Hinsdale

0

0

0

0

1

1

Huerfano

11

36

16

57

10

29

Jackson

5

11

6

22

47

60

Jefferson

20,651

93,547

28,604

123,729

22,662

100,917

Kiowa

0

0

2

4

3

4

Kit Carson

18

82

10

62

25

105

La Plata

18

50

30

51

33

83

Lake

29

91

42

131

84

147

Larimer

416

1,016

643

1,741

514

1,179

Las Animas

12

48

19

88

17

109

Lincoln

31

129

50

237

75

259

Logan

53

194

45

233

41

143

Unduplicated Users and Patient Visits by Colorado County

2020

2021

Trend

2022

L.

25

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

County

Users

Visits

Users

Visits

Users

Visits

Users

Visits

Unduplicated Users and Patient Visits by Colorado County

2020

2021

Trend

2022

Mesa

77

219

95

259

75

166

Mineral

2

7

1

10

1

1

Moffat

14

45

12

36

15

26

Montezuma

7

11

21

38

20

43

Montrose

18

33

31

59

19

49

Morgan

99

422

98

360

136

417

Otero

30

102

22

85

29

140

Ouray

3

4

7

15

1

10

Park

106

371

172

477

143

404

Phillips

8

18

5

22

8

9

Pitkin

17

70

23

58

19

24

Prowers

13

55

16

85

15

41

Pueblo

222

758

251

753

234

774

Rio Blanco

6

15

7

15

4

22

Rio Grande

17

52

28

48

31

111

Routt

38

66

52

105

49

114

Saguache

4

20

12

31

9

42

San Juan

0

0

0

0

0

0

San Miguel

6

8

9

12

14

21

Sedgwick

2

7

4

11

42

79

Summit

118

337

153

490

196

520

Teller

24

54

32

101

31

79

Washington

13

73

24

106

85

142

Weld

1,023

3,609

1,458

4,982

1,355

4,988

Yuma

8

21

18

45

14

19

Total

213,109

963,102

282,964

1,287,417

244,768

1,120,101

L.

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

26

L.

27

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

L.

28

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

L.

29

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

L.

30

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

L.

31

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

L.

32

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

L.

33

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

L.

05

A-2

Emergency

Medical

Services

34

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

35

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix A-2 Emergency Medical Services

1.4

Performance Criteria

Each component of the Emergency Medical

Response Services (EMRS), including the Authority

and Department of Safety, and certain stakeholders,

including the Mayor’s Office, City Council, and

the Auditor’s Office, will designate representation

on the EMRS Advisory Committee, which will

meet regularly to monitor system performance,

identify and recommend strategies for innovation

and improvement, and provide the necessary

collaboration and accountability to ensure continued

high delivery of EMS responses and services. The

performance metrics (including any data parameters

or exclusions), advisory committee composition,

and strategic framework will be documented in a

mutually agreed-upon EMRS Advisory Committee

Memorandum of Understanding. The parties have

recommended improvements to the system and

are committed to continuing improvements to the

system that have improved and will continue to

improve overall system performance. The parties

further agree to monitor all aspects of EMRS

performance, including response times and clinical

outcomes, and to work with each other in good faith

to identify potential options to achieve the desired

EMRS performance, which options may include

but are not limited to, revisiting the current EMRS

performance metrics, staffing or scheduling changes,

alternative response mechanisms, equipment and

infrastructure investments.

Response:

Criteria met

A.

The Utilization/Hour rate will be at or below 0.5

transports/hour (system wide).

Response:

Criteria met

(v)

Authority’s Clinical Criteria. The following clinical

performance measures for each call will be reported

by the Authority in its quarterly performance report:

1.

Median elapsed target of 5 minutes 45 seconds

or fewer from paramedics’ arrival time to initial

recording of 12 lead ECG for suspected cardiac chest

pain.

Response:

Criteria not met

Variance Explanation:

Accurate data collection for 12-lead to STEMI

alert times was a challenge in 2022. Denver Health

Paramedic Division (DHPD) implemented measures

to improve provider documentation and will continue

to investigate cardiac monitor upload issues.

2.

Median elapsed target of 5 minutes or fewer

from qualifying 12 lead ECG to hospital notification

for patients meeting STEMI (cardiac alert) criteria

(targets to be added).

Response:

Criteria met

3.

Median elapsed transport ambulance scene

time of 9 minutes or fewer from time of arrival

to departure for blunt trauma patient meeting

emergency transport criteria. Exclusions to this are

extrication delays, patient access/staging, multiple

patient incidents.

Response:

Criteria met

36

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

4.

Median elapsed transport ambulance scene

time of 6 minutes or fewer from time of arrival to

departure for penetrating trauma patient meeting

emergency transport criteria. Exclusions to this are

extrication delays, patient access/staging, multiple

patient incidents.

Response:

Criteria met

Out-of-hospital cardiac arrest survival rate reported

under the Utstein Criteria definition for long-term

performance purposes and with appropriate

identification of comparison date ranges and lags in

comparison reporting.

Response:

Criteria disposition pending data availability.

5.

The Authority shall be responsible for meeting its

time and clinical performance criteria. The Authority

can meet its response time performance criteria by

meeting the 9-minutes ALS Response time of 90%

from unit assigned to unit arrived.

Response:

Criteria not met

Variance Explanation:

During 2022, the Paramedic Division faced staffing

retention and hiring challenges while experiencing

increased call volume. DHPD has an aggressive

hiring/retention plan and is exploring ways to reduce

demand where possible.

(vi)

In support of the Denver Community Addictions

Rehabilitation and Evaluation Services (CARES),

the Emergency Services Patrol (ESP) will transport

individuals experiencing substance misuse to the

Denver CARES facility. If serious medical problems

are evident, the client is taken by ambulance to

Denver Health Medical Center. ESP van service will

operate sixteen- hours/day seven days/week.

Response:

Criteria met

(vii)

An ESP average response time of 30 minutes

or fewer will be provided, with that time being

calculated as the number of minutes from the

dispatcher notifying the van to the time of arrival

on the scene. A goal of 30 minutes will be set for

contract year 2022 based on available resources.

Emergency Services Patrol:

•

Average response time

Response:

Criteria met

37

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

•

Total calls for service

•

Number of clients picked up per shift

•

Number of shifts worked per month

Response:

Criteria met

(viii)

Reporting – Performance reports will be

analyzed continuously by the EMRS Analyst who

will report to the members of the EMRS Advisory

Committee at least bi-monthly regarding system

performance. A system performance report will

be made at least annually by the EMRS Advisory

Committee to the leadership of the City and the

Authority. The parties recognize that the tiered

emergency response system at times may not

meet one or more goals of the NFPA Standards. The

parties understand and agree that coordination and

cooperation will be needed to share data and provide

system performance reporting.

1.

Compliance – The percentage of responses with

response times less than or equal to the time criteria

identified above for each category and service level;

i.e. how many times out of 100 was the time criteria

met.

2.

Time Performance – Using the same data set as

for compliance, the time (in minutes and seconds)

at which 90% of responses fall at or below; e.g. 90%

compliance for total response time was achieved at

11:00 as an overall EMRS metric.

3.

Exclusions – The count of excluded calls, by type,

will be reported, in each report.

Response:

Criteria met

The required reports have been submitted by the

City’s Director of 911 Communications Center and the

Authority has attended monthly meetings.

06

A-3

Public

Health Services

38

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

39

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix A-3 Public Health Services

1.4 Performance Criteria

A.

The Authority will provide an annual report by May of the following year being reported on, which includes

performance statistics for the year and the two previous fiscal years, for the following items:

Response:

Criteria met

Annual report provided for the metrics listed below.

B.

The Authority will provide the following performance statistics which includes the goals and metrics for

public health functions of Public Health Institute at Denver Health (PHIDH). The frequency of reporting is

provided in the table. Metrics reported monthly will accompany the invoice.

Response:

Criteria met

The following performance statistics were provided Monthly (N/A = statistics without goals):

40

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

41

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Response:

Criteria met

The following performance statistics were provided Quarterly (N/A = statistics without goals):

Response: Criteria partially met

The following performance statistics were provided Semi-Annually (N/A = statistics without goals):

42

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Response:

Criteria met

The following performance statistics were provided Annually (N/A = statistics without goals):

43

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

07

A-4 Denver

Community

Addiction

Rehabilitation and

Evaluation Services

(CARES)

44

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

45

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix A-4 Denver Community

Addictions Rehabilitation and Evaluation

Services (CARES)

1.4

Performance Criteria

A.

One-hundred percent of the women of child-

bearing age utilizing the services of Denver CARES

will be offered a pregnancy test and, if the test is

positive, will be provided referral and follow-up.

Response:

Criteria met

Denver CARES offers pregnancy testing at no cost

to all female patients of child-bearing age. In 2022

there were two positive pregnancy tests and the

patients were referred to Denver Health's Women’s

Services.

•

Number of referrals not admitted.

•

Number of clients admitted for the first time

•

Number of clients referred with a DUI

•

Number of client to staff and client to client

assaults

Response:

Criteria met

See table below for details:

The Authority will provide a quarterly report to the

City in an agreed upon format, which indicates the

amount of year-to-date expenses and revenues

for Denver CARES by the 15

th

day of the month

following the end of the quarter after the end of the

reporting period.

The report will also include the following metrics:

•

Number of clients admitted more than once for

the program year

•

Number of total clients seen in the program

year

•

Number of unanticipated or negative events

(seizures, assaults, and serious injuries)

•

Standard demographics on clients seen in

program year (age, gender, race/ethnicity,

housing status, and Medicaid status)

Response:

Criteria met

See table on the following page. The Denver Health

Finance Department provided regular quarterly

reports to the City with year-to-date expenses and

revenues.

B.

The Authority will provide an annual report by

May 1

st

of the year following the year being reported

on, which includes performance statistics for the

year just ended and the two previous fiscal years,

for the following items:

Detoxification: Average Daily Census

•

Number of clients admitted more than one time

for the program year

•

Number of admissions of clients experiencing

homelessness

•

Number of clients who did not pay any charges

due for services rendered.

46

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

47

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

08

A-6

Medical

Services for

Arrestees,

Pretrial Detainees

and Inmates

48

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

49

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix A-6 Medical Services for

Arrestees, Pretrial Detainees and Inmates

at Denver Health and Hospital Authority

1.6 Performance Criteria and Reports

A.

The Correctional Care Medical Facility (CCMF) is

a Denver Health patient care facility and as such will

comply with Joint Commission on Accreditation of

Healthcare Organizations regulations and review.

Response:

Criteria met

The CCMF follows all Denver Health policies and

procedures aligning with the regulations of Denver

Health's accreditation by the Joint Commission on

Accreditation of Healthcare Organizations. CCMF

continues to be open for Denver prisoner admissions

24 hours a day, 7 days a week. The CCMF is a state-

of-the-art facility, combining both security and

medical care features. Patients are accepted from all

adult-based correctional facilities and jurisdictions.

20 beds (including one dedicated psychiatric

observation room), six holding cells, electronic

surveillance and door control, vehicular sally port,

and a dedicated ten room outpatient area are some

of the key features of this facility.

B.

The Authority will continue to provide the City

with mutually agreed upon standardized Utilization

Management (UM) reports each month.

In addition,

the following information shall be provided to the

Sheriff or his/her designee:

(i) a daily census report for all inpatients at

CCMF or at Denver Health Medical Center

(DHMC);

(ii) within sixty (60) days, monthly patient

data including the patient name, medical

record number, total length of stay, admit and

discharge dates, the Authority charges, City

Cost, patient DOB, split billing information.;

(iii) within sixty (60) days, monthly reports

including ambulance, facility and physician

billing;

(iv) within sixty (60) days, monthly third-party

billing reports including patients name, admit

and discharge dates, split billing information,

sum of charges, sum of City cost, amount

collected from third party, name of third party

payor, credits/debits to City; and,

(v) within sixty (60) days, a monthly A-6 report

and B-3 report as agreed upon by the City and

the Authority.

Response:

Criteria met

All above listed reports were submitted to the City

within required timelines.

C.

The Authority shall continue to develop and

submit financial reports at least monthly to enable

the City and the Authority to evaluate payment

mechanisms and to improve understanding of

costs.

If the ongoing billing methodology work group

(consisting of representatives from the Authority

and the City) agrees, the City and the Authority may

amend this agreement as to payment methodology.

Response:

Criteria met

During 2022, the Authority continued its monthly

financial reporting to include summary and detailed

information. These reports have enabled analyses

of the many different services on various levels.

The current reporting format and content has been

approved by both the City and the Authority.

D.

If any third-party payment is denied or reduced

to less than full payment, the Authority shall provide

detailed documentation of such (including the

stated reason and any available appeal procedures)

to the City within fifteen (15) days.

The Authority

shall timely take such action as is necessary and

reasonable to challenge or appeal the denial or

reduced payment, where warranted under the law

and the rules of ethics as long as the City pays all

necessary, reasonable and preauthorized (in writing)

associated fees and expenses and the City’s written

preauthorization is received within three (3) days of

the Sheriff’s or his/her designee’s receipt of written

notice from the Authority of the denial or reduction.

However, the City shall not pay for the processing

and re-submission of third party claims that can be

accomplished by Authority staff.

Response:

Criteria met

The City is notified monthly of all denials related to

third-party payments. Where there are concerns,

50

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

these concerns are resolved in accordance with the

language outlined above.

E.

Upon completion of providing patient care

services to the City and County of Denver arrestees,

pretrial detainees and inmate population, it is agreed

that the Authority will notify the Sheriff’s Department

of the final medical disposition at which time the

Sheriff’s Department shall arrange for transport

of the detainee or inmate within the agreed upon

median target of 50 minutes.

Response:

Criteria met

See table below for details.

51

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

09

A-7 Denver Health

Medical Plan and

City Employee

Healthcare

Opinion Survey

52

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

53

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix A-7 Denver Health Medical Plan and City Employee Healthcare Opinion Survey

1.3

Performance Criteria

A.

The Health Plan will meet all Performance Standards defined in the annual contract.

Response: Criteria met

At the request of the City and County of Denver, Denver Health Medical Plan (DHMP) provided monthly

utilization and cost reports including data on:

•

Enrollment

•

Medical Claims

•

Pharmacy Claims

Refer to tables below for key performance metrics for the 2022 performance period.

54

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Service Year 2020

Service Year 2021

CSA DHMO

(2,501.05)

$

15,807.28

$

CSA HDHP

(969.72)

$

51,272.25

$

DERP DHMO

632.40

$

2,548.38

$

DERP HDHP

(1,060.09)

$

332,274.66

$

DPPA HDHP

-

$

1,995.26

$

Total

(3,898.46)

$

403,897.83

$

Claim Run-Out Summary - Paid Year 2022

B.

Health Employer Data Information Set, National

Center for Quality Assurance standards will be used

to define the Performance Standards above.

Response:

Beginning with 2020 per mutual agreement, the

HEDIS reporting and performance guarantees were

retired.

1.4

The Authority - City Employee Healthcare

Opinion Survey.

A.

The Authority and the City agree that the

Authority’s Marketing and Public Relations

Department will coordinate with the City’s Executive

Director of the Office of Human Resources to conduct

a Denver City Employee Healthcare Opinion Survey

(“Survey”).

B.

The Survey may be conducted periodically but

no more than every two years with the next survey

scheduled for 2023.

Denver Health will provide a copy

of the Survey to the City’s Executive Director of the

Office of Human Resources.

The Executive Director

has the right to review and approve the timing of

publication and content design of the Survey prior

to publication for coordination with other employee

surveys.

C.

Once the Survey is pre-approved by the Executive

Director of the Office of Human Resources, the

Authority will provide a link to the Survey for

publication in the City’s Employee Bulletin or, if

the Bulletin is no longer available, within the City’s

regular electronic employee communication.

The

survey link will be made available to employees for

up to two consecutive weeks.

D.

The Survey content shall be designed and

prepared by Denver Health at Denver Health’s sole

cost and expense.

The survey will be conducted and

programmed by a market research organization

selected and paid for by the Authority.

The

Survey results shall be considered proprietary and

confidential to the Authority.

The Authority will share

an executive summary of the Survey results with the

City upon request.

Response:

Beginning with 2020, per mutual agreement the

CAHPS reporting and performance guarantees were

retired.

55

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

10

A-8

Rocky

Mountain Poison

and Drug Safety

Services

56

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

57

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix A-8 Rocky Mountain Poison and

Drug Safety Services

1.4

Performance Criteria

A.

Telephone lines will be answered within six rings.

The Poison Center will answer phones 24 hours a day,

365 days a year.

Response: Criteria met

Telephone lines were answered within five rings.

The

Rocky Mountain Poison and Drug Safety (RMPDS)

provides information to health care professionals

and the public 24 hours a day, 365 days a year.

B.

Physicians will respond to complicated, difficult or

unusual cases within 10 minutes of page.

Response:

Criteria met

C.

The Center will maintain certification by the

American Association of Poison Control Centers.

Response:

Criteria met

RMPDS was re-certified in 2017 by the American

Association of Poison Control Centers. The current

certification is effective through 2022.

D.

The Center will provide public education in the

Denver Metro Area.

Response: Criteria met

In 2022, RMPDS distributed 2,480 pieces of public

education materials on poison prevention for human

and animals, in both Spanish and English, in the

Denver Metro area. RMPDS maintains the Colorado

Poison Center website

(www.copoisoncenter.org)

,

that offers one-click contacting for individuals who

may prefer non-telephonic routes of correspondence

(i.e. chatting, email, texting).

Call Volume Trends Analysis:

In 2022, the total Denver & Colorado calls to the

Poison Center got closer to approaching pre-COVID

volumes.

Suicide gestures/attempts by drug overdose in

Denver City and County reported to the Poison

Center have increased slightly (1%) from 2021 to

2022. There were 2 deaths in 2022 which is an 80%

decrease from 2021 (10 reported) and 78% decrease

from 2021 (9 reported) and more closely aligning

with 2019 pre-pandemic patterns (3 deaths reported

F.

The Authority will provide an annual report by May

1 of the year following the year being reported on,

which includes the following information for the year

just ended and the previous Fiscal Year:

Number of calls from Denver County and total State

calls for:

•

Poison Center

•

Drug Consultation Center

Response:

Criteria met

See table below for details.

E.

The Rocky Mountain Drug Safety Services Center

will answer telephone calls within six rings during

working hours 8:00 a.m. to 4:30 p.m., Mountain Time.

Response:

Criteria met

RMPDS answers telephone calls within six rings and

is staffed 24 hours per day, 365 days per year.

58

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

in 2019).

Case severity in 2022 mimicked 2021 (77

cases with major [life-threatening] outcome; 76,

respectively). Cases marked with a “moderate”

medical outcome increased by 12% (422 reported

in 2022, 377 reported in 2021).

Straightforward

cases marked with a “minor medical outcome” or

“no effect” increased by 5.3% over the prior year

(3138 total in 2022, and 2980 reported in 2021).

This

supports the hypothesis that when the poison center

is involved in the medical management of a poisoned

patient, patient outcomes are optimized (resulting in

more cases of minor or no effect, less cases of major

outcomes or death).

By supporting poison center

efforts, we can hopefully improve patient outcomes

when it comes to the poisoned patient, especially

in the setting of complicated or serious exposures.

In summary, overall Poison Center case volume

in Denver City and County increased from 2021 to

2022.

Exposures involving suicide gesture rose 1%,

but exposures resulting in deaths were significantly

decreased by 80% from the prior year.

We hope to

see this reduced fatality pattern continue, and our

efforts in reducing serious outcomes in the poisoned

patient will remain a top priority.

In 2022, we continued to meet the preferences of the

community by supporting an omni-channel platform

(webchat, text-to-chat, and email).

Implemented

in 2021 and continued in 2022, we followed up calls

to the Poison Center hotline with an outbound text

message containing case reference number and

contact information should caller need help again.

In 2022, the Poison Center sent (SMS) as a follow-

up.

These outbound messages improved the caller

experience by making it easy and convenient for

the caller to follow-up while minimizing time Poison

Center staff needed to manually search for cases.

Drug Consultation Center total volumes for Denver

have slightly decreased over the last year; due

to promoting the service to both NurseLine and

Poison Center for inquiries related to safe use of

pharmaceuticals.

Additional volumes can be realized

by promoting the phone line to city agencies that

frequently get such request for information and

RMPDS would like to further that during 2022 in

conjunction with DDPHE.

G.

The Authority will provide a quarterly report to the

City in the format attached to this Appendix, which

indicates the amount of year-to-date expenses and

revenues for RMPDS by the forty-fifth (45th) day after

the end of the reporting period.

Response:

Criteria met

See table below for details.

H.

Requests for consultation services to City and

County of Denver regulatory agencies will be

responded to within 48 business hours.

Response:

Criteria met

59

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

11

A-9 Clinical

and Laboratory

Services for

the City's

Department of

Public Health &

Environment

60

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

61

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix A-9 Clinical and Laboratory

Services for the City’s Department

Environmental Health.

1.4

Specific Time Frame for Performance;

Performance Criteria and Laboratory

Report Delivery.

Clinical and Laboratory Services for the City are a

Core Service as defined in the Operating Agreement.

A.

The Authority’s Department of Pathology and

Laboratory Services (DPLS) shall provide service

24-hours per day, seven days per week.

DPLS agrees

to render Laboratory Services for the patients of

the City in accordance with orders given by the

physicians treating the patient.

Response:

Criteria met

DPLS provided all laboratory services 24 hours per

day, seven days per week, and in accordance with

orders given by the physicians treating the patient.

B.

DPLS shall use reasonable efforts to complete

tests within stated expected turnaround times (TAT)

following receipt of the specimen and the requisition.

In general, TAT should be no more than four (4) days

following receipt of the specimen and the requisition,

unless the test is esoteric, anatomic pathology,

molecular diagnostic testing, or a microbiology test

which requires longer turnaround. DPLS pricing and

TAT for 2022 has been distributed and accepted by

the City.

Response:

Criteria met

99%

of all test results were resulted (reported) within

their established turnaround times as stated by the

laboratory. All turnaround times were met within 24-

72 hours except for specialized tests performed at

DPLS or tests that were sent to reference laboratories

(as noted above).

C.

Routine Histology slides shall be available within

five (5) business days following specimen receipt by

DPLS.

Response:

Criteria met

Turnaround times were met for 99% of routine

histology slides being available within 5 days.

D.

DPLS agrees to deliver a copy of the laboratory

report in a timely manner and per the hospital

laboratory TATs.

The laboratory test report will

include at a minimum: patient's name, date of test,

test name, test result, normal values, laboratory

name and address.

DPLS agrees to make all records

on the City patients to whom DPLS has rendered

services available for the City upon request.

Response:

Criteria met

Copies of laboratory reports were provided upon

request according to the specifications noted and in

a timely manner.

E.

The City shall notify DPLS of any time-sensitive

testing requirements. On request for time-sensitive

laboratory testing, the Authority shall meet the time

requirements of the City whenever possible.

Response:

Criteria met

There were no incidents in which DPLS was notified

of time-sensitive testing requirements by the Office

of the Medical Examiner or another affected City

agency.

F.

If the laboratory is unable to run a requested test

within the TAT specified, it shall immediately notify

the Office of Medical Examiner or other affected City

agency.

Response:

Criteria met

There were no incidents in which DPLS needed to

notify the Office of the Medical Examiner or another

affected City agency of any situations where TATs

could not be met.

G.

All concerns or complaints regarding laboratory

services shall be directed to the Director of DPLS.

Response:

Criteria met

The Director of DPLS was not notified by the office

of the Medical Examiner or another affected City

agency of any concerns or complaints during 2022.

H.

The laboratory code of ethical behavior ensures

that all testing performed by the laboratory are billed

only for services provided. All marketing and billing is

performed in accordance with community standards;

all billing is for usual and customary services. All

business, financial, professional, and teaching

aspects of the laboratory are governed by standards

and professional ethics.

Response:

Criteria met

There were no changes to pricing in 2022. Pricing

is available in the laboratory services fee schedule

which is available upon request. Fees are created

using CMS reimbursement rates and are reviewed

annual for changes.

12

B-1 Center for

Occupational

Safety and

Health (COSH)

and Worker's

Compensation

Triage Line

(OUCH Line)

62

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

62

63

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix B-1 Center for Occupational

Safety and Health (COSH) and Worker’s

Compensation Triage Line (OUCH Line)

1.6

Reporting

A.

Annual Report. The Authority will provide an

annual report by May 1 of the year following the

year being reported on, which includes performance

statistics for the year just ended and the two

previous fiscal years relating to the services provided

to the City under this Appendix B-1.

The report shall

include, but not be limited, the following items for

City employees:

Workers’ Compensation Encounters:

•

Initial visits

•

Follow-up visits

•

Emergency room visits

•

Number of referrals

Response:

Criteria met

See table below for details.

Worker's Compensation Encounters:

•

Average time from initial treatment to

maximum medical improvement (MMI)

Response:

Criteria met

See table for details.

64

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Non-Workers’ Compensation Encounters:

•

By Agency or Department as identified below.

Response:

Criteria met

See table below for details.

Other services:

•

As requested in the prior contract year.

Response:

Criteria met

Other services were not requested in 2022.

B.

Performance Criteria Review:

As part of the

medical management process identified in section

1.4 of this Appendix, the COSH, on an ongoing

basis, shall conduct a performance criteria review

of the services provided by a consultant specialist

as indicated in his/her file for each City employee

65

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

for whom the physician has an open file based

on an COSH referral.

The COSH shall provide the

completed reviews, including all raw data, to the

Risk Management office quarterly at the end of

the quarter in which the review was performed.

In

addition, the Authority and City will jointly identify

and expand the performance statistics measured

and provided by the clinic for work related injuries to

identify areas of improvement.

Response:

Criteria met

The COSH Medical Director and City Case Manager

discuss performance regularly as part of their

monthly meeting.

C.

Other Requested Reports:

COSH shall provide

mutually agreed upon reports as requested by

Risk Management office to quantify services and

workloads, performance metrics, and identify

achievement of best practices.

Response:

Criteria met

Other reports were not requested in 2022.

13

B-2 NurseLine

Services

66

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

67

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix B-2 NurseLine Services

1.3

Performance Criteria

A.

The NurseLine will respond to callers 24 hours a

day, 365 days a year.

Response:

Criteria met

B.

Call Center Agents will intake calls, gather chief

complaint or medical question, and will collect

demographics on calls where medical information is

provided.

Response:

Criteria met

C.

Registered Nurses will provide medical triage

utilizing National Guidelines to arrive at a final

disposition of 911, ED, Urgent Care, Appointment, or

Home Care.

Response:

Criteria met

D.

Calls resulting in a recommendation for medical

care within 24 hours may be provided second level

triage by an experienced medical provider. All

medical providers will be overseen and trained on

DHNL procedures by a Board Certified Emergency

Medicine Physician. Trained professionals will

respond to the caller with medical information,

provide instructions for home care, or recommend

that the caller seek care at a medical facility.

Response:

Criteria met

E.

Language Translation will be provided for callers

through Denver Health medical interpretation

services or appropriate external medical language

interpretation services.

Response:

Criteria met

F.

The NurseLine will strive to adhere to call

center standards set by the Utilization Review

Accreditation Commission (URAC) Healthcare call

Center Guidelines, National Committee for Quality

Assurance Guidelines (NCQA), and the Health

Insurance Portability and Accountability Act (HIPAA).

Response:

Criteria met

G.

The Authority will provide a monthly report

to the City through the Executive Director of the

Department of Public Health and Environment. The

report shall provide numbers for the total and for

the target populations served that month and the

amount of year-to-date expenses and revenues for

the Denver Health NurseLine. The monthly report

shall be submitted to the City by the 20

th

day after

the end of each month.

Response:

Criteria met

H.

In addition to monthly reports described below,

the Authority will provide an annual report by May

1 of the year following the year being reported on

to the City through the Executive Director of the

Department of Public Health and Environment.

The

report shall include the following information for

the year just ended and the previous fiscal year:

NurseLine medical triage cases in total; medical

triage cases for uninsured, medically indigent

patients from the City and County of Denver;

physician medical triage cases; behavior health

cases; all other cases; and medical interpretation

cases.

Response:

Criteria met

See table on the next page for details.

68

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

69

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

14

B-3

Acute and

Chronic Health

Care at Denver

County Jail

and Downtown

Detention Center

70

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

71

DENVER HEALTH

|

REPORT TO THE CITY

|

2022

| Page

Appendix B-3 Acute and Chronic Health

Care at Denver County Jail and Downtown

Detention Center

1.7

Reporting Requirements:

The Authority shall continue to provide the following

reports unless modified by written agreement of the

parties in the Utilization Management (UM) process:

A.

Reports and meetings as required by the National

Commission on Correctional Health Care (NCCHC),

the American Correctional Association (ACA), and to

meet Prison Rape Elimination Act (PREA) standards;

Response:

Criteria met

In accordance with the Jail's NCCHC and ACA

accreditation, Denver Health works collaboratively

with the Denver Sheriff's office to coordinate reports

and meetings. UM is managed by CCMF and Erin

Ellquist is the point of contact. Denver Sheriff Health